In the analysis of medical claim records, it may be helpful to group the records in various ways to enable meaningful analysis of the records for various purposes. Grouping of medical claim data may be accomplished using a number of methodologies, for example, by grouping claim records based upon diagnosis and/or procedure codes (such as ICD (International Classification of Disease) codes and/or CPT (Current Procedure Terminology) codes promulgated by the American Medical Association). Additional grouping methodologies are described in such patents as U.S. Pat. Nos. 5,557,514, 5,835,897, and 5,970,463. These and other existing methodologies support the analysis of medical claims data by various units of analysis, including populations or members, episodes of care or diseases/conditions, and inpatient admissions.
However, the existing methodologies are not as helpful in assessing, for example, the relative performance of surgical specialists and other therapeutic procedures. The groupings created using the known methodologies often include in their group a wide range of other services in addition to the surgical or other therapeutic procedure in question. The wide range of services often includes services that the surgical specialist does not oversee, control or perform. One possible solution is to limit claim groups to services that occur on the same day as the procedure in question. However, such a unit is often too narrowly focused and may exclude meaningful treatment decisions and outcomes before and after the procedure.